Q: Since puberty, I've had very predictable PMS symptoms -- a headache on
the same day every month. I'd take a few Advil and the pain was gone. But now
at age 32, my PMS profile has suddenly changed: no more headaches. Now I get
painfully sore breasts and Advil doesn't help. Why the change, and how should
I treat the pain?

Dr. Donnica: Premenstrual symptoms may vary between women and even within
women. You should consult your physician about this before beginning any treatment
regimen, but the first question she will want to know is whether this is your
only premenstrual symptom. If so, there are several treatment options for your
mastalgia (breast pain). The first is to wear a well-fitted supportive bra. Another
pain reliever such as OTC Naproxen (naproxen sodium) or prescription Ponstel (mefanamic
acid) may provide better relief for you. Some women benefit from taking Vitamin
B6 supplements for the week or two before their menses; others have reported that
oil of evening primrose has been effective. A product called Efamast contains
gamolenic acid (a derivative of evening primrose oil) and Vitamin E and up to
320 mg can be taken per day.

If the pain persists, your doctor may want to order a blood test for prolactin,
the hormone responsible for milk production. If the test shows elevated levels
of this hormone, there are prescription medications such as Parlodel (bromocriptine),
which may be helpful. Studies have shown that prescription Danazol, a synthetic
steroid used to treat endometriosis and fibrocystic breasts, may also be helpful
to treat breast pain (but not other PMS symptoms) during the second half of
your menstrual cycle.

Finally, for severe breast pain, daily prescription Prozac (fluoxetine) or
other SSRI's, may be helpful since breast pain may be related to serotonin release
in the brain which is modulated by these drugs.